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* Digitally connected devices aim to track medicine use
* GSK, AstraZeneca, Novartis all working on smart inhalers
* Innovation drive comes as sector faces growing competition
By Ben Hirschler
LONDON, July 20 (Reuters) - Makers of inhalers to treatasthma and chronic lung disease are racing to develop a newgeneration of smart devices with sensors to monitor if patientsare using their puffers properly.
Linked wirelessly to the cloud, the gadgets are part of amedical "Internet of Things" that promises improved adherence,or correct use of the medication, and better health outcomes.They may also hold the key to company profits in an era ofincreasingly tough competition.
Drugmakers believe giving patients and doctors the abilityto check inhaler use in this way could be a big help in provingthe value of their medicines to governments and insurers, thoughthey need to tread carefully on data privacy.
GlaxoSmithKline, AstraZeneca and Novartis are all chasing the opportunity via deals with devicefirms including U.S.-based Propeller Health andAustralian-listed Adherium, as well as technologyplayers like Qualcomm.
Over the past half century, inhalers have revolutionisedcare by delivering medicines direct into the lungs and avoidingthe serious side effects seen with older oral drugs. But gettingpatients to take their medication correctly remains a challenge.
"Technique is critical. You might have the world's bestblockbuster drug in an inhaler, but if patients don't use itproperly they won't get the benefits," said Omar Usmani, aconsultant physician at Imperial College London.
With asthma and chronic obstructive pulmonary disease (COPD)affecting about 500 million people worldwide, the opportunity islarge, and reducing serious attacks by improving adherence couldsave $19 billion a year in U.S. healthcare costs alone, GoldmanSachs analysts estimated in a report last year.
Usmani envisages a future of high-tech inhalers that notonly record doses but also use gyroscopic and acoustic sensorsto check medicine flow, while monitoring the environment forallergens such as pollen. All that data can be fed to remotecomputer servers known as the cloud.
It is an idea big drug companies have embracedenthusiastically, in the knowledge that they need to find newways to sell their products as cheap generics undercutlong-established brands.
The first generic copies of GSK's Advair, the world'sbiggest inhaler with worldwide sales of nearly $6 billion in2015, are expected to reach the U.S. market next year.
"It's a race to the starting line," Propeller CEO David VanSickle told Reuters, describing the current jockeying amongleading pharmaceutical firms.
"Today, there is really no major respiratory pharma companythat doesn't have a programme to add connectivity to theirinhaled medicines."
NEXT LEVEL
The field is now at an inflection point. Some inhalers withclip-on sensors are already being supplied to patients, but thedrug industry is about to take things to the next level.
Next month, AstraZeneca will start a year-long U.S. clinicaltrial designed to improve adherence to long-term therapy innearly 400 patients with COPD using Adherium's smart inhaler.
If it works as hoped, it could have the same impact onimproving clinical outcomes as a completely new medicine,according to Martin Olovsson, AstraZeneca's head of respiratoryinhalation.
"Many asthma and COPD patients are misusing their medicines,for various reasons - they forget to take them or they don'tunderstand how to take them properly - and the result of that isless than optimal outcomes," he said. "This offers a chance tochange that dramatically."
Last year, a smaller study reported in the journal LancetRespiratory Medicine already showed Adherium's device increasedadherence to preventative medication to 84 percent from 30percent in New Zealand children with asthma.
Now, with bigger studies, drug companies plan to dig deeper.
"There is still quite a lot of work to be done to understandwhich type of patients will benefit most," said Raj Sharma,director of respiratory science and delivery systems at GSK,which is also planning clinical trials.
GSK, the respiratory market world leader since launching theVentolin inhaler in 1969, signed a deal last December forPropeller to develop a customised sensor for its next-generationEllipta inhaler.
While current smart inhalers use a clip-on device to senddata, Novartis, working with Qualcomm, aims to go a step furtherby developing the first inhaler with an integrated sensor, whichit aims to launch in 2019.
Generic drugmakers are also moving into the space, withBritain's Vectura, one of the companies behind genericAdvair, signing a deal with Propeller in May and Teva acquiring smart inhaler firm Gecko Health last year.
Current add-on sensors cost between $10 and $30 to produceand last up to two years, according to Propeller's Van Sickle,but the pharmaceutical industry plans to include them in dealsstruck with healthcare providers by promising overall savingsdue to fewer hospitalisations.
Usmani, the Imperial College consultant, believes provingthe cost-effectiveness of a connected device is the keychallenge for smart inhalers, along with reassuring patientsthat their medical records are secure.
Research by Usmani and colleagues suggests younger patients,familiar with online banking and digital apps, are broadly happyto engage but older patients are more cautious.
(Editing by Pravin Char)
